STAGE 1

Develop a Professional Association

STARTING A NEW OPTOMETRY ASSOCIATION

Associations are formed in order to bring a particular sector together to reach a common goal whether for legislative, educational and/or social reasons. If the country does not have any organized body representing optometry, it may initially take a few committed optometrists in the country to step up to volunteer their time and start an association.

Why is it good to start an Optometry Association?

Growing optometry in a country is best served by one strong professional body that will represent optometrists working in the different sectors (private, public, industry and education). A credible, collective voice with common goals will be able to achieve much more than a number of splinter groups/associations in a country. The association will lobby for the profession to be formally recognized and remain at the forefront of growing the profession of optometry.

As the goal is to represent the interests of the optometrists in the country, it serves a very different role to the optometry regulatory body. However, it is usually the association that advocates for the development of a regulatory body in the respective country.

Setting up the first Board of the association.

Establishing a strong, well-functioning Board is very important for the success and longevity of the association
If possible, choose people who are committed, passionate about optometry development and recognized by their professional colleagues
Select an odd number of people for voting purposes
Try to include individuals who represent different areas of the industry (private, public, industry and education)
Select people who have the time (and in some cases, the money) to give to the new association

The 1^st step for the new Association Board to take:

The new board members must define, in detail, the specific purpose of the new association,
Decide on a name and a logo for the new association. It is usually best to include the profession and country name for a national association eg. Italian Optometry Association or Optometry Association of Chile.

Drafting of the Mission Statement

Use the purpose of the new association as the starting point
Incorporate what will be the member benefits into the statement
Define the Vision of the association in one or two sentences only
Should be a broad statement to allow for change throughout the years

Deciding on who qualifies for Membership

Determine the number of optometrists in the country that could be potential members
Get their contact information to be able to send out information on the association
The letter inviting other optometrists to join must detail the benefits of becoming a member, what will be the annual fees and a membership application form.
Some of the benefits that the association may offer includes

- regular association publications,
- a group insurance plan,
- discounted registration fees to certain meeting(s) throughout the year,
- discounted fees on certain products offered through your corporate partners,
- collective lobbying efforts, etc.

Should the Association be Incorporated or not?

Most associations choose to be incorporated
Most countries/states require incorporated non-profits to hold an annual meeting and take minutes, as well as follow other guidelines
It is highly recommended to consult an attorney regarding incorporation, tax-exempt status and other legal obligations
Once determined, register the association with the relevant government authority to register for taxes etc.
Ensure that the association is well informed

Define what the Income and Expenses of the Association will be

Membership Fees – Whether there will be one set cost for all members or different options based on income, size of practice, individual vs. group practice, etc., the fee structure needs to be reflective of the profession
Non-Membership Income – This could include sponsorships, grants, registration fees, partnerships with industry partners, contributions from Board Members, etc. and is very important to an association’s bottom line since membership numbers will fluctuate from year to year
Annual Budget – Once the income and expenses are determined, it is imperative to set an annual budget based on the projected income and expenses so the Board and its members know how much funding is allocated to each of the activities of the association

Write the Bylaws/Constitution of the Association

The leadership may examine bylaws of other associations to determine how to draft them.
The Bylaws will define the structure of the association, serve as a guideline for procedures, reflect the image of the association and may be required when applying for tax-exempt status
You need to include the following in the Bylaws:
- membership categories and qualifications;
- membership benefits and services;
- appointment procedures for board members, their roles, qualifications and terms of office;
- election procedures
- committees that form the structure of the association and their respective terms of reference
- other topics related to the members and board members

What type of Management is best suited for the Association?

Volunteer Staff – The Board Members would volunteer their time and do everything for the association. May have expenses paid for and receive a per diem for meeting attendance etc.
Volunteer Staff plus Full-Time Employee(s) – The Board Members would volunteer their time along with the required paid employees working out of a central office paid for by the association
Stand-Alone Association – A large staff of paid employees working out of a central office paid for by the association
Association Management Company – Hire an association management company so the association doesn’t have to pay employee benefits and payroll expenses or have the expense of a central office

List of activities that an Optometry Association will engage in:

Support its members in all aspects of professional development
Provide professional guidance and clinical guidelines
Raise awareness of the profession with the public, government bodies and ministries
Advocate the role of the profession in delivering person centered eye health care
Create policies which set out a view as to what should happen or change in the healthcare system
Set up a billing system to collect dues from members
Develop relationships with industry to acquire non dues revenue for financial strength of association
Develop a public relations program to educate the public and other healthcare professions, but which can also be used for governmental agencies, regulators, and administrators
Advocate for the profession with all branches of government and all agencies within the government, and with other health care professions
Monitor all legislation, policies and regulations in the country for any effect they may have on the profession
Develop and advocate for legislation to push the profession forward
Comment on any policy or regulation that may affect the profession
Provide advocacy training programs to educate its members on how to interact and promote any legislation affecting the profession
Provide materials for individual members to use to increase efficient communication about the profession and eye care, both in office and locally
Develop and run continuing education programs for members as required that have a fee to attend
Develop and interact with third party payers to monitor and for possible input regarding reimbursement concerns, covering procedures performed by profession
Monitor the government and other healthcare professions for possible appointment opportunities to committees/commissions of individual members
Work on developing relations with other healthcare professions

Lobby for Recognition

Advocacy means public support for or recommendation of a particular cause, policy or profession.

Lobbying means seeking to influence (a politician or public official) on an issue.

The most essential part of advocacy is getting the public and members of the profession to support your cause. This is often known as grassroots activity and it is what makes advocacy work for the profession of optometry.

The national optometric association of every country, if legally allowed, should be the advocacy body for the profession. The issues for which support is needed should be defined by the association and all the talking points for each issue should also be laid out. It is critical that the association should state a single, consistent message. The association should also be responsible for educating optometrists on how to advocate the message.

Grassroots advocacy starts on a local level, even if it involves national issues and politics. National leaders are appointed and campaign locally in most countries. Members of the profession may need to support the national association or other group lobbying by being prepared to donate money, time, or supplies (pamphlets/venues/sound equipment/office equipment and supplies) for the campaign.

When you are lobbying a member of government for example, the health minister or the designated person (official), you must introduce yourself and educate the candidate on what your organization can do for THEIR CONSTITUENTS/MEMBERS OF THE PUBLIC and how important it is to improve ocular health and ultimately the quality of life of the community. When dealing with the office of the official, do not be disappointed when supporting staff meet you or take your phone calls. They have the direct line to their official, so it is important to engage with them and provide them with professional materials prepared by the national association.

When you get the opportunity to communicate face to face it is important to discuss the issues that affect the profession quickly and ensure that you remain focused on what it is that will benefit the patient/public and NOT the profession. For example, increasing scope of practice will benefit the patient by providing more comprehensive clinical care, saving time, travel, patient choice and cost benefits to the patient and healthcare system. When talking, give personal examples from your practice/clinic about your patients and how the issues affect them directly. You will need to schedule a few appointments to get acceptance of the profession and acknowledgement of the value that it will add to the health system.

Summary: In office meetings with political officials, there are some key points that are important for successful lobbying:

Research the role and functions of the official.
Know the issues very well and keep it short when presenting.
Give a personal story or two about your patients that shows the benefit to their constituents.
Always tell the truth and answers enquiries truthful.
Offer to be an expert contact to the office.
Make sure to do “The Ask” for support.
If you cannot answer a question, do not make up response, but offer to get back with a response.

In countries that need to develop legislation, optometrists must do grassroots work to get to know who are the people involved with legislation. Additionally, those appointed to lobby for support must prepare very thoroughly. They must know exactly what steps are needed from policy development to final legislation. This will help them to know who to lobby at each step in the process. They may also need to approach leaders in other health professional bodies to seek their support in a multi-disciplinary health professions council, when the issues related to optometry arise.

In countries without legislators, most issues will have to go through the Ministry of Health or Department of Health. To develop a personal relationship at this level will be difficult but can be done. A search to find an optometrist who knows the official/administrator will be hard, so one may have to start from ground level. It will take a tenacious, hard-working, small team of practitioners to take on this task.

Remember, to be effective, the relationship with health officials and legislators must be long term, thus having continuity. The message, by the national association, must be presented consistently. Remember, follow up is essential via phone or email. You need to keep the issue in front of them, but do not become a nuisance and have realistic expectations about follow up.

Golden Rules

Don’t underestimate public officials
Don’t look down on government and politics
Be informed
Be understanding of other people’s situations which may alter your plans
Be friendly and cooperative
Be reasonable, practical and realistic
Don’t blame public officials for “failing” to do what you wanted
Be a good opponent
Be thoughtful and learn to evaluate and weigh issues
Don’t break a promise
Don’t change your position in the middle of the stream

The longer you stay involved, the better you will get at interacting with any public official.

Know the complete process to get optometry legislated (a bill passed into law) before taking any action.

Introducing Optometry Legislation

What is a licensed health professional?

Individual accredited by a professional body upon completing a course of study, and usually licensed by a government agency, to practice a health-related profession eg. optometry

How does one become a licensed professional?

Completion of recognized course of study
Licensed by government law to practice
Recognition by regulatory professional body (eg. College of Optometry or Professional Board of Optometry)
Comply with defined clinical & ethical standards of the regulatory body
Remain accountable to the public that you serve through the professional rules and regulations

WCO Definition of Optometry states that it is licensed/regulated:

Optometry is a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.
- Licensed profession
- Boards in each country/state may have their own LRS sub-committee
- Articulates the parameters of the scope of the profession/practice
- Entitles practitioners to practice optometry in country – eg. national exams

What is Professional Legislation?

It is a statutory law of a country
Why is it necessary to have a law?
- Protect the public
  - There is an inherent imbalance of knowledge and power between the patient and the service provider – exposes the patient to a degree of risk.
  - Patients are generally vulnerable & hence at risk
  - Serves as an accepted policy instrument to ensure protection of the public from unqualified, incompetent, or unsafe health care provider.
- Provides professional recognition and monitoring of standards
  - Confers certain advantages to the profession with respect to recognition, credibility, and political influence
  - Only recognizes/approves qualifications from accredited training programs
  - Enables exclusivity to practice the legislated scope of the profession
  - Fosters credibility amongst the public & other professions in the country

Types of Legislation

Generally, if it is the legal/statement of Law that you need, then it is an Act that is required. This is also referred to as primary legislation.

Health Act:
- Primary legislation passed by the Parliament/legislative or equivalent body in a country.
- Defines the broad legal framework for the profession
- Aligned with obligations of the constitution of a country
- Contains the scope of profession & generic rules for professions in the country
- Informs the profession specific regulations

The group lobbying for optometry legislation should review the wording of legislation from countries with similar health systems as the legal terminology is important in laws of countries.

References

Boase, J. (1982). Regulation and the paramedical professions: an interest group study [examines the relationship between government regulation and interest group activity of chiropractors and physiotherapists in Ontario]. Can Public Adm 25, 332–

http://www.businessdictionary.com/definition/health-professional.html

Aldridge S. The Regulation of Health Professionals: An Overview of the British Columbia Experience. Journal of Medical Imaging and Radiation Sciences 39 (2008) 4-10. doi: 10.1016/j.jmir.2008.01.001

Howlett, M., & Ramesh, M. (2003). Studying public policy: policy cycles and policy subsystems. Toronto: Oxford University Press.

http://www.health.gov.za/index.php/2014-03-17-09-09-38/policies-and-guidelines.

https://en.m.wikipedia.org/wiki/Legislation

https://www.slp.wa.gov.au/faq.nsf/Web/Topics/C39627DF9C3527E348256CA8000DCBE5?opendocument